Country Acres New Client Booking Form

Pet Owner/Owners**

First NameLast Name

Phone Number*

Area CodePhone Number

Pet Owner/Owners (spouse, partner, household family member)

First NameLast Name

Phone Number (spouse, partner, household family member)

Area CodePhone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Person

First NameLast Name

Emergency Contact Phone Number

Area CodePhone Number

(BY LEAVING AN EMERGENCY CONTACT NAME AND NUMBER, I AM AUTHORIZING SAID PERSON TO MAKE DECISIONS ON MY BEHALF SHOULD I NOT BE ABLE TO BE REACHED AND UNDERSTAND THAT I AM RESPONSIBLE FOR ANY FURTHER CHARGES INCURRED)

Pet Information

Pet #1 Name*

Pet #1 Breed*

Pet #1 Age*

Pet #1 Weight*

Is the pet spayed/neutered?*

Yes, my pet is spayed/neuteredMy pet is intact and NOT spayed/neutered. (Reminder: Country Acres Pet Boarding cannot provide boarding for pregnant females or females that are in heat.)

Is the pet current on vaccinations including rabies?*

Yes, my pet is current on vaccinations and I will bring updated shot records for Country Acres Pet Boarding to keep on file

Pet's History of Aggression (check all that apply)*

My pet has no history of aggressionMy pet is aggressive towards other animalsMy pet is aggressive towards humans

If your pet has aggression please check all that apply

Any other issues/concerns? (check all that apply)*

My pet has no other issues or concernsMy pet has history of climbing fencesMy pet has history of digging under fencesMy pet gets extremely anxious or scared during times of stress (owner leaving, thunderstorms, ect)My pet has history of destructive behavior (destroying beds, fences, crates, ect)My pet has a history of running awayOther

Pet #2 Name (If no second pet please skip down to vet information)

First NameLast Name

Pet #2 Breed

Pet #2 Age

Pet #2 Weight

Is the pet spayed/neutered?

Yes, my pet is spayed/neuteredMy pet is intact and not spayed/neutered. (Reminder: Country Acres Pet Boarding cannot provide boarding for pregnant females or females that are in heat.)

Is the pet current on vaccinations including rabies?

Yes, my pet is current on vaccinations and I will bring updated shot records for Country Acres Pet Boarding to keep on file

Pet's History of Aggression (check all that apply)

My pet has no history of aggressionMy pet is aggressive towards other animalsMy pet is aggressive towards humansMy dog has history of 'fence fighting' or being aggressive/starting fights with neighboring dogs

If your pet has aggression please check all that apply

Any other issues/concerns? (check all that apply)

My pet has no other issues or concernsMy pet has history of climbing fencesMy pet has history of digging under fencesMy pet gets extremely anxious or scared during times of stress (owner leaving, thunderstorms, ect)My pet has history of destructive behavior (destroying beds, fences, crates, ect)My pet has a history of running awayOther

Veterinarian Information

Veterinarian Name*

Clinic Name*

Clinic Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Clinic Phone Number*

Area CodePhone Number

Boarding Permission/Conditions

Pet Check-In Date*

DateHourMinutesAM/PM Option

Pet Check-out Date*

DateHourMinutesAM/PM Option

Country Acres Boarding Contract/Liability Waiver (PLEASE READ FULLY)

Country Acres Pet Boarding and it's owners understand that your pets are members of your family and agree to exercise due and reasonable care in the handling of pets and in keeping the facilities properly enclosed and sanitary. Country Acres Pet Boarding and it's owners are not liable for loss or damage from natural disaster, disease/illness, theft, fire, death, escape, injury. Country Acres Pet Boarding and it's owners accept no liability for injury or harm to persons or vehicles while on our property, all persons entering the property do so at their own risk. It is expressly agreed by pet owner that any liability shall in no event exceed the lesser of current chattel value of the pet of same breed/quality or the sum of $200 per pet. This contract is valid for all current and future stays.

I HAVE READ, UNDERSTAND, AND AGREE TO THE FOLLOWING:

I agree that I am the legal owner of any pet(s) that I have scheduled to stay at Country Acres Pet Boarding. I agree my pet is not a 'show animal' and does not participate in any dog,cat, or pet shows. I also agree that the pet does not generate revenue or income and there is no anticipated revenue or income in the future.

I agree that my pet is healthy and has not been ill in the past 30 days. If your pet is exhibiting any symptoms that my suggest illness such as sneezing, coughing, wheezing, runny eyes or nose, vomiting, lethargy, or diarrhea please do not bring your pet to boarding or daycare.

I understand that vaccination records from a veterinarian must be presented at first check-in and updated yearly. All pets are required to have current rabies vaccines as well as core vaccinations recommended by your vet. If your pet requires an updated vaccination please make arrangements for the vaccination to be administered no less than ten days before any boarding time is scheduled. All dogs need a minimum of Rabies and (DHPP) vaccination for canine distemper, hepatitis, parainfluenza, and parvovirus. All cats need a minimum of Rabies and (FVRCP) for feline rhinotracheitis, feline calicivirus, and feline panleukopenia

Dogs are recommended to get a Bordetella vaccination every (6) six months as a preventative against kennel/canine cough. The Bordetalla vaccination is not 100% effective and Country Acres Pet Boarding makes no guarantees in regards to its efficacy. Kennel cough is an extremely contagious upper respiratory virus and there is always a risk that a dog(s) could contract kennel cough during their stay even if they are current on the Bordetella vaccinations. The staff at Country Acres Pet Boarding promises to take steps to avoid the spread of this illness but even in the most hygienic, well ventilated, spacious kennels the possibility of a dog acquiring kennel cough still exists.

I understand that all pets must be free from external parasites. If my pet is found to have fleas or ticks they will be treated with dip and/or a topical application of Frontline and a fee of $15 will be charged at pick-up.

I agree to be solely responsible for any and all acts of behavior of my pet while it is in the care of Country Acres Pet Boarding and release Country Acres Pet Boarding of any liability arising from my pet's attendance and participation in daycare or boarding. I agree to disclose any behavioral traits of the pet which may become apparent during the pet's stay. I agree to be financially responsible for kennel property damaged by my pet and any injury or harm my pet causes to other pets or persons.

I agree to provide Country Acres Pet Boarding with an adequate history of my pet and have disclosed any unusual traits, illnesses, injury, allergy, or other issues that my require special care and in the absence of such instruction, acknowledge that ordinary attention and care is reasonable for the pet.

I agree to inform the staff of Country Acres Pet Boarding if my pet is aggressive towards people, other animals, during feeding, with toys, or any other times. For the safety of our staff, animals that are aggressive towards humans or have fear aggression issues will not be allowed to stay at the kennel

Due to the social nature of our kennel and services there are some inherent risk that include, but not limited to, transfer of communicable disease and injury. Injuries may include broken nails, sore feet, puncture wounds, abrasions, and cuts. I understand that my dog(s) will be playing in open areas with other dog(s) and accept that when dogs play in groups they will get dirty, and nicks/cuts/scratches may occur, as well as other inherent risks that are involved and I release Country Acres Pet Boarding from any liability and agree that the staff will not be held liable for any or all problems that may develop. You must notify the staff at the time of drop-off if you do not want your dog to participate in group play.

I understand if my pet becomes ill or if the pet's health otherwise requires attention and the staff of Country Acres Pet Boarding is unable to contact the owner or another authorized person, the pet will be treated as deemed necessary by the first available veterinarian. Medication will be administered as necessary under the direction of the veterinarian. The pet's owner, as listed above, assumes full financial responsibility for any and all expenses involved.

I understand that if my dog is not spayed or neutered they will not be allowed to participate in group playtime with other dogs. Private play is an option for unaltered dogs. Country Acres Pet Boarding will not keep females that are pregnant or in heat.

Payment is due either at drop-off or pick-up. Pets cannot leave until the bill is paid in full. If the pet will not be picked up on the scheduled dismissal date, the owner must contact Country Acres Pet Boarding to make arrangements to extend the animal's stay. A pet that is unclaimed for ten (10) days beyond the scheduled discharge date is considered abandoned and will become property of Country Acres Pet Boarding and will be disposed of publicly or privately. The owner shall remain liable for complete boarding fees as well as other charges incurred in the care, maintenance, and disposal of said pet.

I authorize Country Acres Pet Boarding to take pictures of my pet while participating in kennel activities and use them on its website, social media accounts, and in promotional materials

I have read, fully understand, and agree to the boarding/daycare terms listed above*

Yes. I agree to all the terms listed in the boarding contract/liability waiver and authorize Country Acres Pet Boarding and its staff to provide care for my pet(s) listed on this form.

Boarding Information

Country Acres Pet Boarding is open weekdays 8am-6pm, Saturday 8am-noon, and Sunday noon-6pm

Please call or text 337-317-3659 to let us know you are on your way to pick-up or drop-off so we can be available when you arrive.

Check list of things to bring with your pet -

1. Copy of current vaccination record including rabies

2. We provide bedding but you are welcome to bring bedding or favorite blanket. Note: We do not launder oversized pet beds or bedding. If these things become soiled with mud, dirt, feces, or urine they will be rinsed off with a hose, line dried and returned to owner in a bag.

3. Please bring enough food to last your pet's entire stay. We have food if you forget or dont have enough but many animals get an upset stomach when switching brands suddenly and we want your pet to have an enjoyable stay. There is a charge of $3/day per pet if we provide food.

4. If you pet is on medication please bring medicine in original containers that are clearly labeled with type of medication and dosage instructions. If you do not dose as prescribed then please write down instructions and attach to medication.

5. Please make sure your pet is free of flea/ticks. If external parasites are found your pet will be treated with Frontline or dip at your expense.

If everything is complete, please hit the 'Submit' button below

Thank you for choosing Country Acres, we look forward to your pet's stay!